Advances in the implications of the gut microbiota on the treatment efficacy of disease-modifying anti-rheumatic drugs in rheumatoid arthritis

Junyu Fan; Ting Jiang; Dongyi He

doi:10.3389/fimmu.2023.1189036

Advances in the implications of the gut microbiota on the treatment efficacy of disease-modifying anti-rheumatic drugs in rheumatoid arthritis

Front Immunol. 2023 Sep 28:14:1189036. doi: 10.3389/fimmu.2023.1189036. eCollection 2023.

Authors

Junyu Fan^{1

2}, Ting Jiang^{1

2}, Dongyi He^{1

2

3}

Affiliations

¹ Department of Rheumatology, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
² Department of Rheumatology, Shanghai Guanghua Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai, China.
³ Institute of Arthritis Research in Integrative Medicine, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.

Abstract

Alterations in the composition or function of the gut microbiota are associated with the etiology of human diseases. Drug-microbiota interactions can affect drug bioavailability, effectiveness, and toxicity through various routes. For instance, the direct effect of microbial enzymes on drugs can either boost or diminish their efficacy. Thus, considering its wide range of metabolic capabilities, the gut microbiota is a promising target for pharmacological modulation. Furthermore, drugs can alter the microbiota and the mechanisms by which they interact with their host. Individual variances in microbial profiles can also contribute to the different host responses to various drugs. However, the influence of interactions between the gut microbiota and drugs on treatment efficacy remains poorly elucidated. In this review, we will discuss the impact of microbiota dysbiosis in the pathogenesis of rheumatoid arthritis (RA), and we will attempt to elucidate the crosstalk between the gut microbiota and disease-modifying anti-rheumatic drugs (DMARDs), with an emphasis on how drug-microbiota interactions affect the treatment efficacy in RA. We speculate that improved knowledge of these critical interactions will facilitate the development of novel therapeutic options that use microbial markers for predicting or optimizing treatment outcomes.

Keywords: DMARDs; dysbiosis; gut microbiota; immune response; rheumatoid arthritis.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Antirheumatic Agents* / pharmacology
Antirheumatic Agents* / therapeutic use
Arthritis, Rheumatoid* / drug therapy
Arthritis, Rheumatoid* / etiology
Gastrointestinal Microbiome*
Humans
Microbiota*
Treatment Outcome

Substances

Antirheumatic Agents

Grants and funding

The authors declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the National Nature Science Foundation of China (82104634).